Implications of the clinical gestational diagnosis of ZIKV infection in the manifestation of symptoms of postpartum depression: a case-control study

BACKGROUND: Traumatic events can trigger postpartum depression. Pregnant women in Brazil today are facing an extremely stressful experience. Thus, the objective here was to analyze the prevalence of symptoms of depression in the immediate postpartum period (IPPD) and associate these symptoms with previous stressful, social, psychological, behavioral, obstetrical, clinical, violent and infectious events, particularly exposure to Zika virus (ZIKV) infection during pregnancy. METHODS: This was a case-control study. The sample comprised 213 puerperal women treated in the maternity ward of a public reference hospital in the Araguaia River Valley of Mato Grosso and Goiás, Brazil. Severe IPPD symptoms were confirmed based on the Edinburgh Postnatal Depression Scale (EPDS). A descriptive statistical analysis was carried out using the Epi Info™ version 7.1.5 suite of software tools and the Statistical Package for Social Sciences (SPSS) version 21.0. RESULTS: A bivariate analysis revealed a significant association between “severe symptoms of IPPD” and the following variables: “clinical diagnosis of ZIKV during pregnancy” (OR = 13.36; 95% CI = 5.34–33.39); “was separated or divorced in the last year” (OR = 3.58; 95% CI = 1.42–8.99); “suffered an accident in the last year” (OR = 3.32, 95% CI = 1.12–9.82); “suffered emotional violence during pregnancy” (OR = 3.80; 95% CI = 1.81–7.99); “suffered physical violence during pregnancy” (OR = 11.86; 95% CI = 2.07–67.82); “fear of her partner” (OR = 17.90; 95% CI = 3.44–92.99); “dengue fever during pregnancy” (OR = 7.85; 95% CI: 1.66–37.05), and “has a family member diagnosed with mental illness” (OR = 2.54; 95% CI = 1.09–5.93). The multivariate analysis confirmed the association of severe PPD symptoms only with the variables of “clinical diagnosis of ZIKV during pregnancy” (OR = 19.82; 95% CI: 5.35–73.39) and “was separated or divorced in the last year” (OR = 3.92; 95% IC = 1.12–13.63). CONCLUSIONS: Clinically diagnosed ZIKV during pregnancy may be one of the main events associated with severe IPPD symptoms, showing an almost 20-fold higher chance of occurrence than other factors.